I think it's been quite clearly established that you have violated the TOS on this forum by posting to promote your own business and line your pockets. You may claim an altruistic reason, but it just doesn't appear that way.

I posted that some information you had posted and provided on your website was wrong. I fail to see where you've provided information contrary to my assertion.

In my post #2 on this thread, I provided the reader the complete AME guide provided by the FAA and you discounted this information, yet you post the link to the overall Guide and ask people to drill down to get the information I've provided.

If one goes to the AME informed, there is no "roll the dice" as you propose. If you truthfully don't have reports of apnea symptoms, don't report that you snore, don't report less than restful sleep, and don't have a BMI over 35, you are most certainly in the clear. The STOP BANG sheet you provide does come from the FAA materials, but as everyone can see if you're male, over 50, you would almost certainly think you'd be selected. But you fail to mention that the triage process is much more complicated that the single self-serving form you present. A history is to be taken, clinical observations etc. The FAA specifically references tables to be consulted, and a lot more that you let on. That taken overall overrides the fear mongering you are trying to provoke.

Let's take your point that you think you can smooth the flow by having pilots go to your fly in program and do a sleep study prior to their AME visit. If they do that prior to an AME visit, they have to report it. They will have to provide your complete workup/report to the AME/FAA. Do you think any pilot is crazy enough to do that? For a simple cold, go to a nutritionist and they will find a food problem with you, an ENT will find you need sinus surgery, you'll find a sleep problem is causing the cold, etc. Pilots don't take treadmill stress tests unless they HAVE to. Pilots don't take sleep studies unless they HAVE to. Whether a pilot finds a problem prior to their physical or afterwards, the paperwork and the process is virtually the same. Why put yourself in career jeopardy with you before one has to?

You also conveniently fail to mention that being put in category 5 by one's AME is a process that COULD result in a sleep study, not a process that WILL result in a sleep study. There is a heck of a lot of stuff that goes into the determination of what is needed once a pilot is put in high risk/category 5. Being put in a high risk category by the AME flow chart is NOT a certain need for a sleep study--as much as you would like to convince potential clients otherwise. You fail to mention the Epworth Sleepiness Scale and the Berlin Questionnaire which often provide different results than the "Scary" STOP BANG assessment.

Let's take a look at the process--taken directly from the AME guide:

The AME while performing the triage function must conclude one of six possible

determinations. The AME is

the presence or absence of OSA.

Step 1 -

Applicant Previously Assessed:

Group 1:

Group 2:

Special Issuance. Reports to follow.

Applicant Not at Risk:

Group 3:

Applicant at Risk/Severity to be assessed:

Group 4:

Group 5:

Applicant Risk/Severity Extremely High:

Group 6:

required. Reports to follow.

Step 2 –

Step 3 –

Step 4 –

In assessing airmen for groups 4 and 5, the AME is expected to use their own clinical

judgment, using AASM information, when making the triage decision.

Some AMEs have voiced the desire to perform the OSA assessment.

accordance with the clinical practice guidelines established by the American Academy

of Sleep Medicine.*

*If a sleep study is conducted, it must be interpreted by a sleep medicine specialist.

************************************************** ************************
Group 5 is what MAY lead people to a sleep study. Let's see what the FAA directs for those in group 5:

OBSTRUCTIVE SLEEP APNEA SPECIFICATION SHEET B

ASSESSMENT REQUEST

Due to your risk for Obstructive Sleep Apnea (OSA), and to review your eligibility to

have a medical certificate, you must provide the following information to the Aerospace Medical Certification Division (AMCD) or your Regional Flight Surgeon’s Office for review within 90 days:

•

A current OSA assessment in accordance with the American Academy of Sleep

Medicine (AASM) by your AME, personal physician, or a sleep medicine

specialist.

•

If it is determined that a sleep study is necessary, it must be either a Type I

laboratory polysomnography or a Type II (7 channel) unattended home sleep test

(HST) that provides comparable data and standards to laboratory diagnostic

testing.

It must be interpreted by a sleep medicine specialist and must

include diagnosis and recommendation(s) for treatment, if any.

If your sleep study is

positive for a sleep-related disorder, you may not exercise the privileges of your medical certificate until you provide:

•

A signed Airman Compliance with Treatment form or equivalent;

•

The results and interpretive report of your most recent sleep study; and

•

A current status report from your treating physician addressing compliance,

tolerance of treatment, and resolution of OSA symptoms.

If you are

not diagnosed with a sleep-related disorder or the study was negative

for a sleep-related disorder

, you may continue to exercise the privileges of your

medical certificate, but the evaluation report along with the results of any study, if

conducted, must be sent to the FAA at the address below. All information provided will

be reviewed and is subject to further FAA action.

In order to expedite the processing of your application, please submit the

aforementioned information

in one mailing using your reference number (PI, MID, or

APP ID).

************************************************** ******

How does your personal physician determine if a sleep study is needed:

History of findings that suggest increased risk of OSA include:



Hypertension requiring more than 2 medications for control or refractory hypertension



Type 2 Diabetes



Atrial fibrillation or nocturnal dysrhythmias



Congestive heart failure



Stroke



Pulmonary hypertension



Motor vehicle accidents, especially those associated with sleepiness/drowsiness



Under consideration for bariatric surgery

Symptoms that suggest an increased risk of OSA include:



Snoring



Daytime sleepiness



Witnessed apneas



Complaints of awakening with sensation of gasping or choking



Non-refreshing sleep



Frequent awakening (sleep fragmentation) or difficulty staying asleep (maintenance insomnia)



Morning headaches



Decreased concentration



Problems or difficulty with memory or memory loss



Irritability

Physical/clinical findings that suggest increased risk of OSA include:



High score on an OSA screening questionnaire (e.g., Berlin, Epworth)



Increased neck circumference (>17 inches in men, >16 inches in women)



A Modified Mallampati score of 3 or 4 (assessment of the oral cavity)



Retrognathia



Lateral peritonsilar narrowing



Macroglossia



Tonsillar hypertrophy



Elongated/enlarged uvula



High arched/narrow hard palate



Nasal abnormalities such as polyps, deviation and turbinate hypertrophy

 Obesity (AASM guidelines)

And he will use the information in the AASM tables 2 and 3.

All a lot more complicated that you would lead people to believe. If you have a BMI of 35 or above and don't have hardly any of the findings above, your PCP may determine you don't need a sleep study. If you have a BMI of 35 or above, and you snore or have other major indicators, then you'll get a sleep study. But, in any case, either through what you propose prior to or after the AME visit, the result and process will be the same. So why take a chance on seeing you prior to the AME....it would be foolish!

I love lamp

Loud noises!!!

I am torn on the subject. On the one hand I don't like BMI since it does not account for muscle mass. I gave myself a good body for my 40th birthday -- over a year of intense workouts and diet. At the end of the year I had the least body fat I'd had since college (wrestled intramurals in college, so I wasn't a fatty then). I was muscular to the point where my wife didn't want anymore, and according to BMI charts I was overweight with a BMI of 28. 4 years later and even though I've backed off the gym a bit I've still got much of the same muscle with a little more fat around the waist and my BMI is now 29. I don't snore and certainly don't have sleep apnea, this would be a ridiculous intrusion for me.

Then there is the flip side. One of my roomates in my crash pad sounds like he dies about every 30 seconds while he sleeps. Very fat, looks like shlt, and probably at the high end of obese to low end of extremely obese. He snores like a chain saw, and literally stops breathing every 30-40 seconds. It was scary listening to him. I wouldn't want this guy flying my family around, would you?

I honestly don't have a good answer -- something should be done but this feels like your typical stupid government program that has good intentions but goes about it the wrong way (TSA anybody?). We should do something about people with sleep apnea, but casting a massive net over droves of pilots feels like the wrong approach.

Has he passed his FAA checkride? Then hell yes I'd be fine with him flying my family around. Are you serious man? You're just as bad as the Feds with a comment like that. He snores so all of a sudden he's an unsafe pilot? GMAFB

He's not just snoring, he's suffering from hypopnea/apnea every 30-40 seconds. He needs to see a sleep specialist. OSA messes with REM sleep, causes low O2 sats, and is stressful on cardiovascular system.

He's failing 2 of the IMSAFE criteria (Illness and Fatigue).

I think we should take all of this to it's conclusion. Can't be too safe right? Give everyone 1 calendar year to get their stuff straight then go full bore. BMI less than 30, liver enzymes, cholesterol tests, treadmill stress tests, MRI to check for hidden tumors, neurological testing, psychiatric exam, alchoholism screening, no nicotine allowed, dig deep to find any unknown potential health issue. You never know, might have some pilot out there flying with an undiagnosed illness. Never mind shuting down the air transpoortation system, gotta be safe. Oh yeah, why not a skills test too. I could be dead asleep and outfly some of the idiots I have flown with. I recommend a certain score on an AFOQT and TBAS.

Don't forget to add skin cancer screening for all fair skinned pilots. Ever had a tattoo or piercing? Better add proof you're hepatitis free. What about chicken pox? Well we all know the shingles virus is inside you right. Well you better demonstrate that you don't have shingles. Ever take Advil for a headache? Probably brain tumor.

So, basically the old AA medical :D

BS. How do you know? Maybe he's adapted to this type of sleep and feels fine. He's passed all his check rides. Maybe won't live as long as the rest of us but seriously we're going to also threaten his career? I'm am vehemently against this big brother type medical exam. Billy32's tongue in cheek response illustrates where this is headed if we allow this nonsense to continue.

Absolutely! You can't be too safe! I think we should do this type of screening before every leg, on every day, on every trip! :eek:

Because, well, do you know how many airline accidents have been caused by all those unhealthy pilots?

I just hope nobody at CNN finds out about this! Where's the guy with the goatee in the 777 sim? We need him to straighten this mess out! :rolleyes:

I am also opposed to the big brother approach, but from what MikeF16 describes, in this one case, that person needs to be checked out. One does not adapt to "waking up" every 30-40 seconds, nor do they probably know they are suffering from it or even realize they are "waking up". I use the term "waking up" loosely. During an apnea, the O2 sats drop and the brain fires a message to get more oxygen. The person is not consciously aware of this.

It should not threaten his career, simply get his OSA treated.

I had OSA, did not know it (family doc suspected), had the sleep studies, did the CPAP and finally surgery to correct it. Occasionally, I would dream of being suffocated, and truly wake up gasping for air.

I don't deny that OSA is a serious issue and should be treated on ones own time and at ones own personal decision. I don't accept the FAA and AME diagnosing this and then having guys lose their medical over it. It goes way too far.

And to reiterate I will not be effected (affected?) by this whatsoever. I'm in the normal BMI range. My dad worked for the company that made the bipap and cpap. So I know how serious and widespread an issue it is and how shortsighted using BMI is.

Sleep apnea is clearly a fatigue issue. May not make you bust a checkride but you might fall asleep or make a huge screwup after a long day (or night).

I think they need a reasonable screening mechanism, whatever that might be, but just letting OSA slide by is probably not the right answer. They wouldn't let any of that other stuff you mentioned slide if they had reason to suspect. And maybe establish a grace period give folks the opportunity to make sure they don't have OSA.

So how many accidents have been attributed to OSA? if we can't find any, then let's start digging into other issues that have never caused an accident. Like old age when guys fall asleep in the cockpit more often. We need to start testing for that too, probably have to sit with the AME for 8 hours with a radio call every 20-60 minutes and see if they stay alert and awake.

So unless you want to start digging into things that have not caused accidents, I'd suggest we fight against this intrusion whether if affects you or not.

It's starting to sound like the Air Force's 'Fat Boy' program has migrated to the Airlines via the FAA.

You guys hash it out, I've got to go ride my bike now!

I'll probably be hit by a 92yr. old driving a Cadillac, or a kid driving while texting, but let's not worry about things like that, which we can easily stop, things that kill thousands of people every year on the highways.

Let's just pick on the fat guys who are flying airplanes and have never had an accident...

The best government money can buy!

Maybe we also need to test the AMEs prior to our physical? And politicians prior to their votes--wouldn't want them voting on a defence bill, for instance, on not enough rest!

We should definitely push for FAA inspectors to have the same standards, as how could they safely inspect us if they themselves are unsafe?! :D

Why not? Hasn't been an issue for the over 100 years we've been doing this now. Maybe the Wright brothers had OSA?! We better start from scratch.

Any AME that sends a bunch of his customers to get 'screened' for this needs to be put out of business. If you've read anything from Dr Tilton, you'll see that they're expecting ~90% of pilots to have sleep apnea. And that includes the pilots that look like they've just been liberated from Auschwitz. So just because you're skinny doesn't mean that you won't eventually be a target of this silliness.

'Specialists' such as the OP will likely find 100% of 'fatties' have OSA. The FAA's going to take that information and continue to tighten the standards until 'specialists' like the OP have lined their pockets with every pilot's money. Because they're going to find that every single pilot has OSA, based on their screening criteria.

Let's take this 'waking up every 30-40 seconds' to the next silliness. Any pilot who has a colicky child should be required to stay in a hotel room so that they can get uninterrupted sleep.

No pilot can stay at any hotel that does not have totally soundproof rooms so that they get undisturbed sleep.

No pilot should be permitted to consume alcohol because it's been proven to disrupt your sleep. All pilots will be required to take antabuse.

Ah, the Big Brother silliness. George Orwell was just a couple of decades too early. I'm trying to shop for a top loading washer - thanks to .gov regulations, it's impossible to find one that gets your clothes clean. Thanks, Big Brother.

More regulations to fix nonexistent problems is always a good idea. In a totalitarian society. And anyone who favors this OSA silliness is getting the government that they deserve.

Exactly.

Oh and while we're at it, go to sleep in some perv's office while he watches you all night with a million wires and cameras hooked up to you knowing all the while that if you don't sleep perfectly it goes in your permanent record but hey, we have to keep our babies safe!

Idiots.

"Work is the only place I can get any sleep."

Prior to kids I slept 7-8 hours per night, could go longer. Then kids. 3 hours of interrupted sleep was a dream that was flat out unachievable for almost 4 years. Now I wake up ready to go after 6 hours whether I am at home or on the road.

Maybe you shouldn't be allowed to have kids and fly. Maybe you just shouldn't be allowed to fly ever,for any reason, it's just not safe.

Again, 40 bmi is a starting point but the goal is to test every pilot regardless of bmi. Theyll be happy to have a fat lazy but osa free guy with a bmi of 42 flying while an osa guy with bmi 23 and a great marathon time is grounded. Anyone who thinks this is about weight or health is asleep at the wheel and will be caught off guard and shocked at the FAAs solutions.

http://i938.photobucket.com/albums/a...psd1a86991.png

Wow! Now there is a doctor with a G O D complex.:mad:

Denny

Sounds to me that dr tilton owns stock in a chain of sleep clinics.

Truth is if this starts taking down pilots in a pilot shortage time the Tilton osa program will come to a quick end.

Or be amended. Maybe you should be given a medical while you find and then continue your treatment?

And especially while the FAA figures out how they actually want this treated. I think the first moment I heard of this I thought like others this was about bmi and having a healthy bmi, but the moment they said losing weight was not a faa approved solution then it became apparent their focus is not on flight safety or health but rather surgeries. Even if those surgeries have not proven themselves to be an effective solution. For some weight loss is a solution, for some it's not but I doubt removing parts of your throat (in some cases) is wise.

But of course this is the faa that requires me to wear glasses with a combined vision of 20/15.

FTB, thanks for posting that comment from Tilton. I read it quite a while ago. f you look around a bit, you'll find where he expects ~90% of pilots to be diagnosed with OSA.

If these guys think that OSA is such a problem, they should demand that every FAA employee be subjected to OSA testing. But they're not doing that.

So where is all the FAA research on accidents which shows how much more likely a pilot with a BMI over 40 is to have an accident, vs. a pilot with a BMI under 40, or 35, or 30?

It's total crap and typical FAA nonsense, trying yet again to find a cure (at your expense) for a problem that doesn't exist!

Where is the evidence that OSA has been the cause of any accident?

Why do you assume Dr Tilton had a good reason to create such a program?

There's more money in the treatment than in the cure, of course.

Create a problem, then charge your insurance company through the nose to treat it!

It's quite a racket.

At my overseas airline, if when taking your Flight Physical you are above a 30 BMI you're required to go thru extra tests, sometimes consisting of sleep study, ECG testing as well as a lipid profile. If you're above 33, you're tempo grounded while doc decides what wasteful, expensive and utterly ridiculous tests outside the company medical clinic he/she can think of for you to be referred to…. and you get below 33.

I'm quite amazed they started at BMI of 40 with the FAA. That's a big boy!!

Last year, I asked the doctor to show me where it said a sleep study was required if I was over 30 bmi for my Flight Physical and a few days later he sent me something saying "should" instead of "Shall" or "Must". Didn't argue…. wasn't going to win.

Our clinic doctors have turned into a bit of the Chinese astronaut physical type doctors. They still think everyone is a 21 year old marathon runner.

Something to know: There is NO treatment required for "Mild Sleep Apnea". Just go on your way.

Can't wait to leave this slave ship!!

Hey… you gonna eat that last slice of pizza?? :-)

Kap

BMI charts are completely inaccurate and wear originally designed for people who don't work out. As a former body builder, this could be detrimental to ones career. I am 6'2" and weigh 260. However, my body fat percentage is less than 1O percent (muscle weighs more than fat). I am in better shape than most people I know.

Not quite as lean as you GV, about 17% but that's the same battle I fight with flight quacks, health and life insurance, the Navy Reserve, etc.

You're a BMI of 33.4: you're obese!
Isn't there some sort of caliper test? Some of us don't fit in these charts accurately.

We need to improve the medical retirement payouts. This could be pretty lucrative.

Get fat, get paid. Like where you're headed with this one.

but the moment they said losing weight was not a faa approved solution then it became apparent their focus is not on flight safety or health but rather surgeries.

........what..........:confused:

if you have a high Bmi and osa and the Feds ground you and you say, hey, let me lose weight and maybe the osa will go away, (according to those who've been down this path) the faa will say no. Losing weight is not a solution, surgery is. Hence, this isn't about weight but osa.

People are getting (understandably) sidetracked over Bmi. The faa doesn't care about your bmi whether you have 20, 30, 40, doesn't matter. They are just looking for osa. So to them:

• BMI 40 pilot, no osa...... good to go.
• BMI 23 pilot, no sleep issues at work, but osa..... grounded required treatment.

So while some may rejoice in fat pilots getting faa scrutiny, truth is, fat pilots with no osa will have a medical, skinny pilots with osa will not.

Keep this in mind, osa is the target, what causes osa?

sleep apnea is linked to High blood pressure, obesity, aging, alcohol, sedatives, smoking.

Well, if you're the faa and you want to stop all these osa related accidents, you're going to have to test everyone unless you can find a pilot who has low blook pressure, skinny, doesn't drink, doesn't smoke, no sedatives and isn't getting older.

What happens if you have a BMI of 35 and a 17 inch neck but raise no concerns when questioned by your ME?

Do you snore?---No, never.
Do you sleep soundly throughout the night?---Yes, always.
Do you experience daytime sleepiness?---No, never.
Do you suffer from hypertension?---No.
Do you smoke?---No.

Does the ME simply mark you down as showing no signs of OSA?
If so, won't everyone just learn the correct answers to the diagnostic inquiries?